the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Tuesday, December 05, 2006

mpumalamga is burning

the capital of our province is a beautiful town called nelspruit in the lowveld (subtropical region in the east). actually i should give it it's dues and call it a city, because that's what it has become over the last few years. at independence roughly twelve years ago, witbank was the bookie's favorite for the capital, but the politicians had other plans. i suspet nelspruit was chosen because of it's beauty, which is a far cry from the dusty wind swept plains of the highveld upon which witbank situated. witbank is also the source of most of the country's coal, a large proportion of which is burned in many nearby power stations supplying the country with electricity. the pollution is therefore quite something.having said all this, there is one thing that witbank does have and that is proximity to pretoria, the capital. witbank is merely one hour's drive away. nelspruit is about three and a half hours away.

for some reason this proximity to pretoria makes witbank with it's pollution and grasslands a more attractive option for many professionals, including surgeons. but despite this there is an absolute shortage of surgeons in the state sector in the entire province. there are only two with full registration in the whole province and both of them are in witbank. therefore i wasn't surprised when the state approached me about 4 months ago and offered me a post in the capital, nelspruit. brimming with enthusiasm, i rushed to nelspruit the next day to scout the place out. it is quite a drive and the toll gates add exponentially to the irritation thereof. but still the beauty of the place seemed to get under my skin and i was quite keen, especially that they mentioned a significant increase in salary.i waited for the official offer. and i waited. and waited. nothing happened. i knew from a friend in nelspruit that they only had one surgeon with limited registration and he was only covering half the month's calls. that meant they were referring most of their serious cases to witbank after hours. this didn't seem to bother the administration. not only did this not bother them, but they decided to further sabbotage services by no longer paying the by now severely overstretched surgeon for after hours services rendered (actually they said they'd pay 25% which ammounts to about R300 for a night's work probably in the region of $40). he cut his overtime by half. now nelspruit, the capital only has surgical cover for 4 days every month.

during this time, surgical services in the entire province collapsed, partly due to the 25% after hours policy by the government, but also due to the fact that the overtime owed to the medical officers was three months behind. they felt that they could no longer go on working in excess of 80 hours overtime per month with no renumeration.

with this as a backdrop, the province once again engaged me in dialogue about a move to nelspruit. they were also canvassing a recently qualified surgeon from pretoria, who was soon to be unemployed because his time at the academic hospital had come to an end. the head of the depatrment of health for the province was however reluctant to ok the ammount initially offered to us. he seemed not at all phased by the total lack of surgical cover in his own city. he clearly has medical aid, and would never have to receive treatment from one of the hospitals he administrates, so he doesn't care.

the last i heard was that they would take at least a month or two to simply organise a transfer for me and between 4 to 6 months to appoint the new surgeon. the question of a higher salary has totally fallen by the wayside. apparently desperate times do not in fact call for desperate measures. the fact that they don't consider what the new surgeon is going to do to make ends meet in that time is absolutely typical. what he will most likely do is find a cushy post in private and earn three times what they are offering. once he is settled, why would he then move.

from my side, possibly because i'm foolhardy, i'm still thinking about the nelspruit offer, but i have slowly come to the sobering realisation that this province does not care for the health of it's people.last weekend, the administration was forced to send a gunshot abdomen patient to be operated in private because there was not one single state surgeon on call in the entire province. the costs of that alone could start approaching the amount they would be required to pay for an entire month's overtime of one surgeon in the state. the money is there, it's the will on the part of the administration to make it work that is lacking.

every day i find my resolve to stay in the state more difficult to maintain. i still feel that evil prospers where good men do nothing, but in a system that simply does not care about the lives of it's people it is very difficult to not be seen as part of that system by the casual observer. most people that hear i work for the province of mpumalanga assume i'm on some form of remedial community service imposed by the council for some or other medical misdemeaner. maybe it is time to consider another avenue of employment and allow the ship to finally sink as the administration so badly wants it to do.

2 comments:

I did my week of Surgery in Witbank about four or five months ago (the PAH surgeon actually arrived in Witbank for the first time in the middle of our time there)and it was right when everyone was starting to go 'on strike' because of the massive backlog owed by the government to the doctors. The situation in Mpumalanga is apalling, but the worst part is that it's spreading: I finished off in neurosurgery a few weeks ago in Gauteng, and the doctors there were also complaining about how much they were owed. Between about four neurosurg regs, the government owed something like R200 000.00. At one of the meetings with the powers that be, the government representative just looked at the doctors blankly and said 'But where do you expect us to find that money?' So they also went on strike, and there were no neurosurgeons on call for a while. It's absolutely ridiculous. And instead of spending good money on qualified specialists who actually provide a decent service, the government will spend a fortune on sending hundreds of students to Cuba each year so that they can come back here and repeat every rotation five times before they finally sort-of competent. Pathetic.

i couldn't agree with you more. the other frustrating thing is why must that government lackey even ask them where they must get the money from. they got the service, they should pay for it. canyou imagine a builder builds a house and afterwards the developer says but where am i supposed to get that money from??? anyway, the services in mpumalanga have collapsed and still they don't take action. i really get the feeling there is a concerted effort by the powers that be to actively destroy the services.

one more thing, in mpumalanga they have budgeted for the staff they are supposed to have. bearing in mind that 86% of specialist posts are not filled, there is plenty of money available. yet they refuse to pay extra overtime to the specialist surgeons that they do have. i can't help wondering whose pocket that money eventually lines.

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.